How does chronic renal failure primarily affect bone health?

Chronic renal failure adversely impacts bone health primarily through disturbances in calcium and phosphate metabolism. In chronic renal failure, the kidneys are unable to excrete phosphate adequately, leading to hyperphosphatemia. This elevated phosphate level can cause a decrease in serum calcium levels, as high phosphate binds to calcium, resulting in secondary hyperparathyroidism.

The parathyroid hormone (PTH) is then released in response to low calcium levels, aiming to mobilize calcium from bones and increase renal reabsorption. This process not only affects bone density but can also result in conditions such as renal osteodystrophy, where bone structure and strength are compromised. Over time, this imbalance can lead to weakened bones, making fractures more likely due to both decreased mineralization and alterations in bone turnover.

Understanding this relationship is crucial in managing patients with chronic renal failure, as addressing the metabolic imbalances can help mitigate the risk of bone-related complications.